CKD Stages: The Progression of Chronic Kidney Disease. Caring for your kidney disease at every stage. Copyright 2005 Fresenius Medical

CKD Stages: The Progression of Chronic Kidney Disease Caring for your kidney disease at every stage. Copyright 2005 Fresenius Medical

STAGES 1 and 2 Stage 1: Kidney damage with normal or increased Stage 2: Kidney damage with mild decline in Stage 1: Greater than 90 Stage 2: From 60-89 Stage 1: High blood pressure, urinary tract infections, abnormal urinalysis (test of the urine) Stage 2: High blood pressure, urinary tract infections, abnormal urinalysis (test of the urine) Goals for Stage 1&2: Diagnosis and treatment of underlying disease (hypertension, diabetes, etc.) and/or infection, treatment of other medical conditions, slow down the progression of CKD, reduce risks of complications. See your Primary Care Physician (PCP) on a regular basis to have your blood tested for health problems. Ask these questions: What is my blood pressure? Am I at risk for high blood pressure? What is my A1C? (diabetics only) What is my cholesterol? Am I at risk for high cholesterol? Seek information about health problems and Chronic Kidney Disease, and attend a Fresenius TOPs session in your area. Make healthy lifestyle changes; quit smoking, exercise regularly, eat healthy (see a dietitian for specific recommendations), reduce stress, get enough sleep. Get medical attention for health problems like headaches, fatigue, increased thirst, frequent urination or burning during urination, unexplained weight gain or loss. Know your flow - ask your doctor for your GFR and monitor it regularly according to his/her recommendation. STAGES 1& 2

STAGE 3 Moderate decrease in From 30 to 59 Low blood count, malnutrition, bone pain, abnormal nerve sensations such as tingling and numbness, reduced mental functioning and sense of well-being Goals for Stage 3: Evaluate your condition with your doctors and treat complications. Slow down the progression of the disease by treating the underlying condition (hypertension, diabetes, etc.) and modifying therapy for those conditions as required. See your doctor and discuss changes in your lab values and symptoms you may be experiencing. Ask your doctor the following questions: Do I have high blood pressure? Is my blood sugar high? What can I do to lower it? What is my A1C? (diabetics only) Am I at risk for anemia? What is my albumin? Is my diet giving me what I need? Is there something I should add to my diet? Am I at risk for malnutrition? What is my cholesterol? How can I lower it? Get a referral to a Fresenius TOPS Session; begin with a visit to a nephrologist (a physician who specializes in kidney disease). Work with your Fresenius UltraCare team (PCP, Nephrologist, Nurse Practitioner, Registered Dietitian and Social Worker) to correct anemia, malnutrition and bone disease. Get further information regarding kidney disease and learn how you can slow its progression. Control blood pressure, blood sugar and high cholesterol. Take all medications as prescribed. Continue with healthy lifestyle changes. Get support from your Fresenius Social Worker. Your Social Worker will assist you in finding support groups, financial assistance, employment counseling and answer insurance questions. Know your flow - ask your doctor for and continue to monitor your GFR. STAGE 3

STAGE 4 Severe decline in From 15 to 29 Severe complications such as anemia, high blood pressure and bone disease Goals for Stage 4: Control blood pressure, blood sugar and cholesterol. Prepare for kidney replacement therapy, learn about different ways to treat kidney failure, have access created for dialysis. Speak with your Fresenius TOPs educator regularly (PCP, Nephrologist, Nurse Practitioner, Registered Dietitian and Social Worker). Get education regarding renal replacement therapies and talk about your options with your Fresenius TOPs educator to decide the best choice for you. Read the Fresenius Medical Care Patient Handbook for ESRD Patients and ask questions. Educate yourself and your family as thoroughly as possible. Request placement of your access. For hemodialysis either a fistula or a graft are considered the best options. For peritoneal dialysis a PD catheter is placed in your lower abdominal area. Visit a local dialysis center and ask for a tour, this is a great opportunity to ask questions. STAGE 4

STAGE 5 Kidney Failure Less than 15 Uremia (build up of waste products in your blood), anemia, malnutrition, hyperparathyroidism, high blood pressure, swelling in hands/legs/eyes/sacrum, shortness of breath Goals for Stage 5: Dialysis or kidney transplant. Treat other medical diseases and complications. Follow the prescribed renal replacement therapy as planned. Get involved with a Fresenius Medical Care dialysis center or transplant program. Be an active participant in your renal care. Keep taking medications and/or attending dialysis sessions as prescribed by your doctor. This is extremely important to your health and well-being. Seek needed support (social, financial, etc.) by asking your Fresenius Medical Care Social Worker for assistance and/or resources. See your doctor for changes in your health; cold or flu symptoms, new or unusual symptoms/problems, and changes to, or worsening of, existing symptoms/problems. Get education about lifestyle changes to expect as a transplant or dialysis patient and ask questions. STAGE 5

Your TOPs Educator: Phone Number: Email Address: NOTES:

Fresenius Medical Care North America 920 Winter Street Waltham, MA 02451-1457 For more information about the Treatment Options Program Call Toll Free: 1-877-TOPS-LIFE (1-877-867-7543) www.ultracare-dialysis.com Copyright 2008, 2010 Fresenius Medical Care North America. All rights reserved. The following are trademarks or service marks of Fresenius Medical Care Holdings, Inc. or its affiliated companies Fresenius Medical Care and UltraCare. All other marks are owned by their respective companies. TOP024 (4/2010)